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Synovial sarcoma of the oral cavity – a case report
E-Poster Presentation mandible in one case each. Only frontal bone was involved in two cases. Fifth case had multiple lytic lesions in maxilla and frontal bone. All patients consistently showed very high values of alkaline phosphate and parathormone. Hypercalcemia and hypophosphatemia was noted in four cases. All cases showed regression of the lytic lesion after parathyroidectomy obviating the need for surgical excision of the jaw lesions. Conclusion: Giant cell lesions associated with PHPT in oral and maxillofacial region are rare clinical entities. The prevalence of PHPT associated giant cell lesions is 5.9%. They are clinically, radiologically and histopathologically similar to any other peripheral or central giant cell tumour. Relevant history may alert the clinician and altered biochemical values may help in correlating the oral and maxillofacial findings with the underlying systemic disease. http://dx.doi.org/10.1016/j.ijom.2015.08.290 The role of denosumab in the management of central giant cell granuloma – a case report K. Rajaram ∗ , P. Davies, P. Selby, A. Kalantzis Manchester Royal Infirmary, Manchester, United Kingdom Background: Central giant cell granuloma of the jaw is a locally aggressive benign intraosseous proliferative lesion. Various non-surgical treatments have been employed in the past with recent research focused on the use of Denosumab. Denosumab is a monoclonal antibody, which is a receptor activator of nuclear factor kappa B ligand (RANKL) inhibitor. These block osteoclast activation from osteoclast precursors. Osteoclast precursors express surface receptors called RANK (receptor activator of nuclear factor kappa B) which is activated by RANKL. This activation promotes maturation of osteoclast precursors into osteoclasts and Denosumab blocks this activation. Here we present a case of central giant cell granuloma treated successfully with Denosumab. With very few case reports reported in literature we share our experience with Denosumab. Methods: We present a 29year old lady with central giant cell granuloma of the anterior and left body of mandible involving the inferior border. Surgical management would have necessitated an en-block resection with free flap reconstruction. The lesion was treated with two doses of Denosumab injections. Clinical and radiographic follow-ups were recorded over an 18 months period. Results: Post-operative visits revealed that her symptoms had resolved. CT scans revealed significant bony infill with almost complete opacification of the cavity and calcification of the lesion thereby confirming good osteoblastic activity. Conclusion: Clinical and radiological response to Denosumab suggests that it is a suitable treatment option for central giant cell granuloma. However larger case series and further research is essential to provide more information about long-term results and possible complications with Denosumab. http://dx.doi.org/10.1016/j.ijom.2015.08.291 Synovial sarcoma of the oral cavity – a case report K. Rajaram 1,∗ , A. Patel 2 , M. Patel 1 1 2
Wythenshawe Hospital, Manchester, United Kingdom Medical Student, Leeds Medical School, United Kingdom
Background: Less than 50 cases of intraoral synovial sarcomas have been reported in medical literature. The term is
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essentially a misnomer as these malignant tumours do not arise from synovial tissue and very rarely occur within joint spaces. They originate from pluripotent mesenchymal spindle cells. They form 6–10% of all soft tissue sarcomas and only 3 – 10% are in the head and neck region. Here we present a 16 year old female patient who presented with synovial sarcoma involving the tongue and floor of the mouth. History and presentation: Patient’s symptoms included swelling & pain in the floor of mouth of 2-3 years duration. Initial investigations with MRI scan suggested a possible diagnosis of a vascular lesion. The calcified lesion was excised due to continuing symptoms and histopathology revealed a synovial sarcoma. Results and conclusion: Literature reveals that synovial sarcomas are commoner in males and most often present as painless lumps. Most common in young children and adolescents, they present as calcified mass on scans and this was found in our patient as well. Curative treatment of sarcomas involves wide surgical resection and chemotherapy may be recommended for metastatic disease. Presentation of synovial sarcomas can be variable, unsuspected and normally only confirmed on histopathology. Our patient underwent further resection of the area to obtain clear pathological margins and she remains symptom free to date. We believe it is important to document and report such cases as it leads to better a understanding of the behaviour of this tumour and raises awareness of this neoplasm. http://dx.doi.org/10.1016/j.ijom.2015.08.292 Outcome analysis of the use of preformed titanium implants in orbital floor reconstruction V. Ramani ∗ , K. Balaraman, S. Raja Sabapathy Ganga Hospital, Coimbatore, India Background: Fractures of the floor of the orbit are one of the most common of facial fractures sustained following an RTA. Prompt treatment and adequate reconstruction of fractures of the floor of the orbit leads to better outcomes. This study was conducted to evaluate the fracture pattern of the orbital floor and assess the outcome of pre-contoured orbital titanium implants for its management. Objectives: To study the fracture pattern of orbital fractures and evaluate the outcomes of using pre-contoured titanium implants for management of orbital floor fractures. Material and methods: The study sample for this hospital based prospective study was derived from 77 patients presenting to Ganga Hospital from 2011 to 2013 for evaluation and management of orbital floor fractures. All patients were evaluated clinically and with computed tomography (CT) scans to assess the fracture pattern. Where indicated the patient was operated upon and floor reconstructed using pre-contoured titanium implants. Follow up evaluation was done to assess for complications such as temporary or permanent diplopia, enophthalmos, paresthesia over infraorbital nerve territory and evaluation of surgical scar and complications related. Results: Of the 77 patients, 29 patients of the study group required reconstruction of the orbital floor defect which was done with titanium implants. No infection or implant extrusion was noted. Diplopia and enophthalmos was lower than other modes of orbital floor reconstruction.
Wythenshawe Hospital, Manchester, United Kingdom Medical Student, Leeds Medical School, United Kingdom
Background: Less than 50 cases of intraoral synovial sarcomas have been reported in medical literature. The term is
e279
essentially a misnomer as these malignant tumours do not arise from synovial tissue and very rarely occur within joint spaces. They originate from pluripotent mesenchymal spindle cells. They form 6–10% of all soft tissue sarcomas and only 3 – 10% are in the head and neck region. Here we present a 16 year old female patient who presented with synovial sarcoma involving the tongue and floor of the mouth. History and presentation: Patient’s symptoms included swelling & pain in the floor of mouth of 2-3 years duration. Initial investigations with MRI scan suggested a possible diagnosis of a vascular lesion. The calcified lesion was excised due to continuing symptoms and histopathology revealed a synovial sarcoma. Results and conclusion: Literature reveals that synovial sarcomas are commoner in males and most often present as painless lumps. Most common in young children and adolescents, they present as calcified mass on scans and this was found in our patient as well. Curative treatment of sarcomas involves wide surgical resection and chemotherapy may be recommended for metastatic disease. Presentation of synovial sarcomas can be variable, unsuspected and normally only confirmed on histopathology. Our patient underwent further resection of the area to obtain clear pathological margins and she remains symptom free to date. We believe it is important to document and report such cases as it leads to better a understanding of the behaviour of this tumour and raises awareness of this neoplasm. http://dx.doi.org/10.1016/j.ijom.2015.08.292 Outcome analysis of the use of preformed titanium implants in orbital floor reconstruction V. Ramani ∗ , K. Balaraman, S. Raja Sabapathy Ganga Hospital, Coimbatore, India Background: Fractures of the floor of the orbit are one of the most common of facial fractures sustained following an RTA. Prompt treatment and adequate reconstruction of fractures of the floor of the orbit leads to better outcomes. This study was conducted to evaluate the fracture pattern of the orbital floor and assess the outcome of pre-contoured orbital titanium implants for its management. Objectives: To study the fracture pattern of orbital fractures and evaluate the outcomes of using pre-contoured titanium implants for management of orbital floor fractures. Material and methods: The study sample for this hospital based prospective study was derived from 77 patients presenting to Ganga Hospital from 2011 to 2013 for evaluation and management of orbital floor fractures. All patients were evaluated clinically and with computed tomography (CT) scans to assess the fracture pattern. Where indicated the patient was operated upon and floor reconstructed using pre-contoured titanium implants. Follow up evaluation was done to assess for complications such as temporary or permanent diplopia, enophthalmos, paresthesia over infraorbital nerve territory and evaluation of surgical scar and complications related. Results: Of the 77 patients, 29 patients of the study group required reconstruction of the orbital floor defect which was done with titanium implants. No infection or implant extrusion was noted. Diplopia and enophthalmos was lower than other modes of orbital floor reconstruction.